


The Big C

by ladymac111



Series: Miss Holmes [5]
Category: Sherlock (TV)
Genre: Angst, Cancer, Doctors, Gen, Hurt/Comfort, M/M, Medical Procedures, Parentlock, apparently sort of fluffy even though I was aiming for angst, background Johnlock, based on my life, papillary thyroid carcinoma, thyca
Language: English
Status: Completed
Published: 2012-10-04
Updated: 2013-07-10
Packaged: 2017-11-15 15:04:09
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 5
Words: 9,253
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/528561
Author URL: https://archiveofourown.org/users/ladymac111/pseuds/ladymac111
Summary: <blockquote class="userstuff">
              <p>A routine medical exam turns up a nodule in Alexa's thyroid, and she's forced to confront the leftover trauma from her mother's death.</p><p>Rated Teen for language and heavy themes.  Possible squick warning for non-explicit descriptions of medical procedures.</p><p>I've decided this is "canon" with the other Miss Holmes stories.  It takes place when Alexa is sixteen, about two years after she comes to live with Sherlock and John and one year after they officially adopt her.</p>
            </blockquote>





	1. Nodule

**Author's Note:**

  * Inspired by [Miss Holmes](https://archiveofourown.org/works/4278615) by [ladymac111](https://archiveofourown.org/users/ladymac111/pseuds/ladymac111). 



> So, admittedly, this story is very personal for me. It's very heavily based on my own experiences, then twisted as needed to apply to these characters. So there will probably be a lot of me in this, as much as I'm trying to make the characters themselves and not self-inserts/Mary Sues (has been a fear of mine from the beginning with Alexa). Please let me know if they seem OOC, because I want to see how they would deal with this situation, and not just recreate what happened to me.
> 
> I'm writing this now because it's been a year since my own cancer journey started. I don't consider this story “canon” with my other stories about Alexa, but it needed to be written. So … it's an alternate universe, I guess? There will be hurt/comfort vibes, and it will inevitably be angsty. Hope you enjoy this, at any rate.
> 
> Finally, I'm assuming that all the medical procedures I underwent in the States are the same as what would be done in England. Every procedure that happens is one that I personally went through.
> 
> And a little random silliness ... the two doctors in this chapter are named after Physics textbooks, and the doctor we'll meet later is named after a Chemistry textbook. I don't know how people come up with names ... I get them from the worst possible sources. (A dream, a famous sci-fi author, and now textbooks. What's next, types of tea?)

John didn't think he would ever get used to waiting rooms, but this one was especially awkward – he'd never been to a gynaecologist's office before, and he hoped he never would again. The woman across from him was ignoring him so carefully, he wished he could just run away. He wished he hadn't come along, or that at least Sherlock was there too, so he could be the centre of attention and John could fade into the background and stop feeling like a creeper.

Finally the door opened, and Doctor Holt poked her head out. “Doctor Watson? We're all finished. Could you come back, please?”

John stood up. “Come back?”

She held the door for him. “If you would, please. There's something we need to discuss.”

John's mind was whirling with possibilities, each more horrible than the last, as the doctor ushered him into the exam room where Alexa was pulling her shoes on. “Hi, Papa.” She gave him a smile as he sat down beside her, and his heart rate calmed just a little.

“I know you're imagining all sorts of awful things,” Dr Holt said, sitting down facing them. “Let me reassure you that Alexa's in very good health all around. But I did notice something out of the ordinary when I checked her neck.”

John's mind was still buzzing, and he tried to calm it. “Her neck?”

“Yes, I always do neck checks on my patients. I'm sure you know, there are plenty of women who don't go to a GP regularly, so I try to help make up for it.”

John took a deep breath. “And what did you find?”

“There's a nodule in the left lobe of her thyroid.”

The buzzing stopped, suddenly, and John's mind was blank. “Alexa, can I …?”

“Sure.” She turned her back to him and lifted her chin.

Carefully, he palpitated her neck. Sure enough, there was a small lump to the left of her trachea. He removed his fingers, but trailed a comforting hand over her shoulder as she turned back. “Feels small. It's probably nothing. Most thyroid nodules are.”

Dr Holt nodded her agreement. “True. But I think it's important that she see an endocrinologist to be certain. I can give you a referral, if you like. I know one who specializes in thyroids; he's very good.”

“Yeah, that would be great. My professional connections aren't what they used to be.”

Dr Holt smiled as she pulled out a notepad and started writing. “Alexa was saying, medicine isn't really your career these days.”

John chuckled and Alexa leaned into him fondly. “No, it's not. Her Dad is my career; being a doctor just pays for groceries and lets me prescribe the good painkillers when Sherlock fractures his ribs.”

Dr Holt tore the paper off the pad and handed it to him. “Doctor Enrico Giancoli. He's the other side of London, but he's worth it, I promise.”

John stood up. “Thanks a lot. Anything else, Alexa?”

She shook her head. “No. Everything's great, except for the neck bump, apparently.” She put her fingers on her throat and felt around gently. “I can't feel anything.”

“It takes some practice, knowing what's normal and what isn't,” John said. “Thank you, Dr Holt.”

“Of course,” she said, standing and showing them out. “And please let me know how everything goes, okay?”

“Sure thing.”

 

When they got back home, Sherlock was sitting in his chair, watching them intently as they hung their coats up. “You have news,” he said without preamble. “What happened?”

John and Alexa exchanged a glance, and John let out a sigh. “Alexa has a thyroid nodule.”

Sherlock's eyebrows rose. “A thyroid nodule.”

John rolled his eyes. “Yes, that's what I said.”

“A lump, Dad,” Alexa said. “I can't feel it, but Papa and Dr Holt both can.”

“A _lump_ ,” Sherlock said carefully. “Can you be more specific?”

John shook his head and sat heavily in his chair, across from Sherlock. “Not at the moment. All we know is it's pretty small. But we've got the name of a good endocrinologist; he'll probably do an ultrasound and a biopsy.”

Alexa arranged herself on the end of the couch. “You said it's probably nothing, Papa. What could it be?”

John pinched the bridge of his nose as he tried to remember. “It's been a long time since I was up on this, but ... I know the majority of thyroid nodules are either cysts or benign tumours. Around five percent are cancerous, but over half of those are a type that's non-aggressive and curable, especially when they're caught early.”

Alexa had gone very still, and Sherlock flicked his eyes to her, even as he spoke to John. “It could be cancer?”

“It's really unlikely,” John said.

“But not impossible.”

“No, but it is _really unlikely_.”

With a swift motion, Sherlock moved from his chair to Alexa's side and wrapped an arm around her shoulders. “Are you all right?”

She tried to nod, but it wasn't convincing. “I … cancer?”

“Ninety-five percent chance it isn't,” Sherlock said.

“We're not rolling dice,” she said, her voice eerily calm. “It either is or it isn't. We just don't know yet.”

Sherlock didn't take his eyes off her. “John, what are the risk factors for thyroid cancer?”

“I … I don't think there are any, really. No inheritance component, no environmental factors, unless you've had unusual radiation exposure. There isn't a pattern to it.”

“You're certain there's no inheritance component?”

John frowned. “I'm not _certain_ , but I'm fairly sure.”

Sherlock finally looked over at him, and John was startled by the fear hiding in his eyes. “Would you check me?”

“What?”

“My neck. Check my neck and see if my thyroid is normal. You examine the rest of me a lot, but never my neck, not really.”

“Okay.” John moved across the room, perched on the couch, and placed his fingers on Sherlock's pale neck. “Chin up,” he instructed.

And then his heart sank. Why had he never done this before?

As always, Sherlock knew. “What is it?” he asked softly, in the tone he used when he already knew.

“You have a nodule too.” John couldn't keep his voice from cracking as he spoke, even as his fingers continued to gently probe. “More than one, actually.” He swallowed hard. “Feels like one in the right lobe, and two in the left. Hard to judge size, but they're not very big.” He glanced over Sherlock's shoulder at Alexa, just as her eyelids fluttered, and his trauma training kicked in. “Shit! Sherlock, she's going to pass out!”

They scrambled, and in less than ten seconds she was on her back, her legs elevated across Sherlock's lap while John brushed the hair off her forehead. Her eyes opened again, slowly.

“It's all right,” Sherlock murmured.

“Take deep breaths,” John instructed. “You're okay. Just having a little panic attack.”

She blinked a few times. Her glance flicked between them, and there was an edge of hysteria in her voice. “Dad has thyroid nodules too?”

“They're probably nothing,” John said, doing his best to sound reassuring. “And so is yours. The odds are in your favour.”

She tried to blink away the tears that came to her eyes, but instead one spilled down her temple as she looked up at John. “I've heard that before. When Mum was ...”

“Shh,” John said, patting her hair. “Everything will be okay.”

She shook her head, and more tears fell. “You can't promise that.”

John pressed his lips together in a grim line. He couldn't.

 

Alexa gripped John's arm and watched with wide-eyed fascination as Dr Giancoli pressed the needle into Sherlock's neck. “Here comes the first sample,” he said. “Can't tell right now what sort of nodule it is.”

“It doesn't look like a cyst on the ultrasound,” John said. “It's the same consistency as the rest of the thyroid tissue.”

“Hmm.” He withdrew the needle, and the nurse took it. “All right, Mr Holmes?”

“Yes,” Sherlock said.

“Does it hurt, Dad?” Alexa asked.

“Not at all, it's completely numb. Just a little pressure. I can't even feel the cold of the ultrasound gel any more.”

Dr Giancoli chuckled at that. “Someday, they'll invent ultrasound gel that's actually comfortable.” He moved the wand around a little bit and watched the monitor for a moment, before taking the needle from the nurse. “I think we'll take one or two more from this nodule, then do the same for the one in the other lobe.”

Sherlock sighed and re-settled his head backward over the bolster, baring his long throat once again. “Get on with it, then.”

Fifteen minutes later, the nurse wiped the gel off Sherlock's neck, and he buttoned his shirt back up. “Your turn now,” he said to Alexa as he hopped off the table.

She nodded silently, and took his place. Her fingers shook as she unbuttoned her blouse.

“Don't worry,” Sherlock said softly. “You're brave. It's nothing to be afraid of.”

“Who said I was afraid?” she asked, but there was a tremor in her voice.

“Only the anaesthetic injections hurt,” Sherlock said, moving to stand by her side as she lay down and tipped her head back, exposing her neck for the procedure. “And those are just a pinch. The rest is easy.”

“Don't lie to me, Dad.”

“I'm not lying.”

“Yes you are. You get this look when you lie, and you have it now.”

A guilty expression came over Sherlock's face, and he glanced at John, who gave him a sad smile. “It's true. What aren't you saying?”

Sherlock took a deep breath, and let it out slowly. “I wasn't lying about the pain. But the pressure is … unnerving.”

Dr Giancoli came back in, and Sherlock left Alexa's side with a brief squeeze to her shoulder. “Ready for your turn, Alexa?” the doctor asked.

She closed her eyes. “As ready as I'll ever be.”

Sherlock silently took John's hand, and they held on tight.


	2. Diagnosis

**Summary for the Chapter:**

> Dr Giancoli calls with the results of Sherlock and Alexa's biopsies, and the family are left to cope with their new truth.

A week to the day after the biopsies, Sherlock's phone rang, and he had never picked it up faster in his life. “Sherlock Holmes.”

“Hello, Mr Holmes, this is Dr Giancoli.”

Sherlock gestured to John, who quickly joined him at the table. “You have the biopsy results. John is here; I'm putting you on speaker so he can hear too.” He pressed the button, and set the phone between them.

“Hello again, Dr Watson.”

“Yes, hello. What's the news?”

 

John was in the kitchen making tea when he heard the front door open and shut, and Alexa's tread on the steps to the flat – right on time, just like every day. He brought the three mugs into the sitting room, and Sherlock snapped his laptop shut as Alexa entered. She eyed them suspiciously. “What's going on?”

John handed her a mug. “Have a seat.”

Her eyes went wide with realization as she sat next to Sherlock on the couch. “Dr Giancoli called, with the biopsy results.”

John took the chair facing them. “Yes.”

“Oh my god. Dad, are you okay? What is it?”

“I'm fine,” Sherlock said, laying a hand on her knee. “I have a pair of benign tumours, and they just want to do some blood work to make sure my thyroid function is normal.”

She sighed and sank back into the couch, her tea forgotten on the table. “Oh thank god.”

John continued, very carefully. “But your nodule, Alexa … it's not benign. You have a papillary carcinoma.”

Panic crept over her features. “I … I have cancer?”

Sherlock wrapped an arm around her, and John did his best to keep stoic. “Yes. The good news is, this type of cancer is very slow, and we've caught it very early. In cases like yours, the cure rate is almost one hundred percent.”

She took a few slow breaths, obviously trying to calm herself. “So … what do we do?”

“We find a surgeon,” John said. “They'll remove your thyroid, and check if the cancer has spread within your neck, which is common, even in early stage. When you've recovered from the surgery, about six or eight weeks later, you'll do a targeted radiation treatment to wipe out all of the remaining thyroid tissue in your body. After that, you'll just have to take a pill every day to replace the thyroid function, and get regular check-ups to be sure it isn't coming back.”

“Sounds … pretty easy?”

“It is. We understand this cancer very well, and we know how to cure it. Yours is very early stage, so a complete cure is practically guaranteed.”

“There's no way this cancer can kill you,” Sherlock said softly. “As long as you do the treatments, everything will be fine. And there's no rush – this cancer grows very slowly. Dr Giancoli said a tumour your size has probably been growing for at least five years, and it would be five to ten more before it started being dangerous.”

“It sounds like you've been doing research.”

“I found a website and sent it on to you. Thyroid Cancer Survivors Association. They have a lot of good information.”

She leaned into him, and he held her closer. “How long will I have to be in hospital?”

“Just one night, after the thyroidectomy,” John said. “The radiation is an outpatient procedure. You'll have to go on a special diet to prepare, but the treatment itself is a single pill, followed by an at-home quarantine for a few days.”

They were silent for a while, and John watched the mess of emotions that contorted Sherlock's face as he held their daughter.

Finally, she spoke. “I have cancer.”

Sherlock looked at John, pleading, _Say it isn't true_. “I'm afraid so, sweetheart.”

Tears rolled down her cheeks, abruptly freed, and she turned her face into Sherlock's shoulder and began to cry silently. John crossed the space between them and sat by her side on the couch. He held them both for a long time, but his own tears never came.

 

John woke the next morning feeling oddly unsettled, and it took him a moment to realize why: the shower wasn't running. He rolled over and checked the clock – 7:15, long after Alexa was usually up and getting ready to go to school.

He got out of bed, gently escaping Sherlock's embrace, and pulled on his dressing gown before heading upstairs. Alexa's door was ajar, as usual; he knocked quietly as he pushed it open and stuck his head into the darkened room. “Alexa?”

“Morning, Papa.” Her voice was flat and muffled by the blankets she was wrapped in.

“It's almost half seven,” he said lamely.

“I know.”

John's concern grew, and he crossed to sit on the edge of her bed. “Are you okay?”

“How could I be _okay_?!” she demanded, suddenly furious. “I've got _cancer_!”

John wasn't sure how to respond to that, not without a meaningless platitude that would not benefit either of them. Instead, he laid a hand on her shoulder, and felt the shuddering sobs that rolled through her.

“I'll call you out, I guess,” he said.

She nodded, and he gave her shoulder one final squeeze before he got up. “Shout if you want anything, okay?”

She nodded again, and he reluctantly went downstairs. Sherlock was in the kitchen, preparing two cups of tea. “She needs time to process,” he said, handing one to John. “I've already called the school. How is she?”

“She's in a pretty bad place,” John said, fiddling with the tea bag as the brew darkened. “She's terrified.”

“It reminds her of her mother,” Sherlock said, sitting down at the clear end of the kitchen table. “She can't separate this situation from that one. To her, cancer means you get very sick, and you spend months in and out of hospital doing all sorts of unpleasant procedures. Surgery, chemotherapy, radiation. The treatment only makes you sicker, and in the end, the cancer wins and you die in pain.” He looked up at John, who was staring blankly into his mug. “What do we do? How do we help her see that this won't be like that?”

“We carry on,” John said, with more conviction than he felt. “We don't let on that we're afraid too.”

There was a long pause. “You're afraid?” Sherlock asked.

“Yes,” John said quietly. “Aren't you?”

“I am. But it's irrational. The odds of this going any way but smoothly are astronomical. This is the best cancer you can get.”

“There's no such thing as a _good cancer_!” John snapped, and Sherlock looked away in shame. “Others are worse than this, but it isn't fucking _good_. And it's not like she had to go to the cancer shop and pick one to have. She didn't choose this, and having it doesn't mean that she can't get other cancers later in life. This is a horrible situation that nobody wants to deal with, but we don't have a choice.” He dropped into the chair at the end of the table, drained by his outburst.

One of Sherlock's pale hands covered his as they clutched the mug. “We'll be strong for her,” Sherlock said. “But we won't lie. I won't deceive her.”

“I can't do that either,” John said, and then the tears came, all of them, without warning.

Sherlock gathered him into a tight embrace and John gave up on control as his fear and grief soaked the shoulder of Sherlock's best dressing gown, and his hands clutched his husband's shoulders as though he might evaporate if he let go.

 

It was noon by the time Alexa came down and showered, and then arranged herself in her favourite spot on the couch with her laptop. Sherlock lowered his violin and turned to her. “Good morning, princess. Can I get you anything?”

Her eyes were still red from crying, but her voice was steady and she raised an eyebrow. "Princess?"

"Sleeping Beauty."

“Some tea would be lovely, Prince Charming.”

He set his violin on the table, and went to put the kettle on. “John's at Tesco. Do you want anything?”

“Actually, I was thinking of baking a cake.”

“Baking a cake?”

“Yeah. Marie's going to come over after school, and we're going to have a 'fuck cancer' slumber party.”

Sherlock couldn't help but grin. “Don't let your Papa hear you say that, he likes to think you're innocent and pure. And you didn't ask if Marie could stay over.”

“You've never said no before, and I can't imagine you'd say no now.  Besides, it's Friday.”

“I'm sure we wouldn't.”

“I'll text Papa and tell him what to buy for the cake.” She pulled out her phone and started typing. “You want chocolate?”

“It's not about what I want; it's your cake.”

“Let me pretend it's not all about me, okay?”

He came back into the sitting room and set himself down facing her. “Alexa, you don't have to do this.”

“Do what?”

“You know very well what you're doing. This is big. It's _huge_. I won't have you diminishing it.”

She couldn't meet his eyes. “I don't want to be a burden.”

“You are _not_ a burden. You are my daughter and I'm going to take care of you in every way you need me to.”

She managed to look back up at him, and her expression was a mixture of relief and love. “Thanks, Dad. It's … it's good to hear you say it.”

“I know I'm not good at this,” Sherlock said. “But I want to try to be better. For a long time I believed that caring about people was a dangerous disadvantage, and I had many experiences that seemed to confirm this. But you and John … I can't help but care. You've both changed me, and I need you to be here for me. In exchange, I need to be there for you. And I find I _want_ to be there for you. So please … let me be your father. Let me take care of you.”

She dropped her phone on the coffee table and wrapped her arms around Sherlock. He froze for a moment, then returned the gesture, and he felt her smile as she pressed her face into the side of his neck. “I love you, Dad.”

 

Only a quarter of Alexa's cake remained, and the girls had just started their third film of the evening – _Titanic_ , now, after _Eternal Sunshine_ and _The Notebook._ John decided he'd had quite enough and dragged Sherlock off to bed, despite the other man's protests that he wasn't tired.


	3. Thyroidectomy

**Summary for the Chapter:**

> Alexa has her thyroid removed while John and Sherlock try to stay sane.

John's first impression of the surgeon Sarah had recommended – Dr Stacy Zumdahl – was that she was entirely too good to be true. She came into the small exam room where the three of them were crowded – Alexa on the chair, John and Sherlock pressed together in the corner – and greeted Alexa with a kind smile and a confident handshake before turning to John and Sherlock, who introduced themselves as Alexa's fathers.

“I'm so sorry to hear about your diagnosis,” she said as she sat down facing Alexa. “I see a lot of thyroid cancers, but it doesn't get easier. How have you been doing?”

“I'm all right,” Alexa said. “We got the diagnosis three weeks ago, and it was pretty bad at first, but it's getting better.”

Doctor Zumdahl smiled. “I'm glad to hear it. And I can promise you, it will only continue to get better. Can I feel your neck?”

“Sure.” Alexa turned her back and raised her chin, and Dr Zumdahl's slim fingers moved expertly.

“There it is. Pretty small.” She took out a piece of paper as Alexa turned back. “The operation you're going to have is called a subtotal thyroidectomy. The goal is to take out as much of your thyroid as we can, but due to the anatomy of your neck, getting all of the tissue isn't possible.”

She started drawing on the paper. “A thyroidectomy is a major-minor operation. Minor, because the incision is very small, we don't have to cut any muscles, recovery is quick, and it's very unusual for there to be complications. Major, because the position of the thyroid in your neck is right next to a lot of very important things that we have to be careful to avoid.” She pointed to the drawing as she spoke. “Your thyroid is shaped like a butterfly, and it's wrapped around your windpipe. Your laryngeal nerves, which control your vocal cords, actually go right through it.” She drew some swooping lines. “The greatest risk is that we damage one of them. If it were to get completely severed, it would paralyse that half of your voice. If both get cut, the vocal cords would be completely paralysed and closed, and you would need a tracheotomy in order to breathe.

“Don't worry, though,” she said quickly, picking up on Alexa's expression as John moved to put a comforting hand on her shoulder. “I've never had that happen. We actually have a special piece of technology to help us avoid those nerves. During the surgery you'll have a breathing tube in, and there are electrodes on the sides of the tube. If we push on the nerve, the larynx will twitch, and one of our monitors will go _beep_ so we know what we've touched. The tube might bruise your voice a little bit, so you might be hoarse for a day or so after the surgery, but I've only had two patients with permanent damage to their voices, and they were both older people whose tumours were large and actually wrapped around the nerve – and even then, the cancer was already affecting their voices, and it was only slightly different after the surgery. Based on the ultrasound pictures Dr Giancoli sent me, your tumour is quite small, and not near the nerves at all.

“After the laryngeal nerves, the greatest risk is bruising your parathyroid glands, which sit right behind the thyroid. They control the calcium in your body, so you'll be taking large dose calcium supplements right after the procedure to be sure that you have plenty. If you do get any hypocalcaemia, it will only last for a few days.

“As far as the other things in your neck, we consider them technically at risk, though in practice they're perfectly safe. You have a few major veins and arteries here, and farther back are your oesophagus, and then all the way at the back you have your spine, but we have no reason to go that deep.

“Finally, you have lots of lymph nodes in your neck. It's common even in early stage for cancer cells to spread to them, so we'll take a few during the operation and send them to a pathologist along with the thyroid. If you have metastases, we'll recommend that you do a radioactive iodine ablation to kill those cells, and all of the rest of the thyroid tissue that we couldn't scrape out without risking damage to other structures.”

“How often does that happen?” Alexa asked.

“It used to be, we recommended the ablation for everyone,” Dr Zumdahl said. “I'd say about 80% of my patients have metastases, and some of the ones without choose to do the ablation anyway, just to be on the safe side.”

“How long is the recovery after the operation?”

“We'll do the operation first thing in the morning, and then keep you overnight. As long as you don't have any complications, you'll be able to go home the next day. I usually recommend that you take a week off school or work, though some people feel well enough to go back right away. Since you're rather small, I'd guess that you'll probably want the time off. We can't use a muscle relaxant on you like we do for most operations – otherwise the fancy breathing tube won't work – so we have to knock you out a bit harder than usual, and it will take a while to shake that. Besides which, you'll probably have a bit of pain and swelling, and you'll get some narcotic painkillers for that. I'll also prescribe you a starting dose of thyroid hormone replacement, and after you've recovered you'll work with Dr Giancoli to find the right dose for you.”

“How long does that usually take?” John asked.

“There's a lot of variation. Sometimes we get it right on the first try, other times it can take up to a year.”

“What about scarring?” Sherlock asked.

“The incision is usually four or five centimetres,” the doctor said, holding her fingers up to her own neck. “We try to do the cut in one of the creases that are already on your neck, and we use plastic surgery techniques to close it. It's in a very prominent spot, but after a while it's all but invisible, especially if you use scar healing gel on it. I've got one on the back of my wrist, here, from a carpal tunnel procedure.” She held her hand out to Alexa, and flexed at the wrist. “See the little white line in the crease? That's what your scar will look like after a couple of years.”

“I can hardly see it at all!”

Dr Zumdahl smiled at her. “It's obvious to me, but nobody else ever notices it until I point it out. Yours will be the same.” She looked between Alexa and the two men. “Do you have any more questions?”

“How often do you do this procedure?” John asked. “You come highly recommended, but we like to form our own opinions too.”

“Fair question. I usually do one or two thyroidectomies a week, and probably about seventy-five or a hundred every year. I've been doing this for about fifteen years now, so I've done thousands of them.”

“And only two had permanent complications?” Sherlock prodded.

“Yes, and like I said, those were cases of advanced cancer. Even still, both of those patients did very well after, with the exception of the vocal changes. Alexa's case will likely be better even than typical, since she was diagnosed so early. From the ultrasound, it looks like it might even be a microcarcinoma, less than a centimetre. Those have an excellent prognosis; it's a wonder yours was found at all, it's so small.” She looked around at all of them. “Do you have any more questions right now?”

“I don't,” Alexa said, and her fathers nodded their agreement.

“Very good,” the doctor said, and shook all of their hands again. “I'll be up at reception for a few minutes, if you'd like to schedule the surgery right away.”

She closed the door as she left, and John visibly relaxed. “That went rather well.”

“Yes, I thought so,” Sherlock said.

“Well, Dad? What did you deduce about her?”

“Nothing of interest, really. She didn't lie about anything, and she's probably even better than she lets on. She takes a personal interest in all of her patients, possibly due to a negative experience in the past, either hers or someone close to her. She does this because she wants to make people's lives better, and even though she knows she already has, many times over, she has a touch of imposter syndrome and feels the need to prove herself anew every time.”

“Fantastic,” John breathed, and Sherlock rolled his eyes.

“She also colours her hair and her husband is a primary school teacher, but that's not important. I think we should schedule the operation.”

Alexa nodded. “Me too. I like her, and I want to move forward.”

“Well, then,” John said, moving to the door and pulling it open, “here we go.”

 

Six weeks later, they all rose early and went together to the hospital, where the early-morning staff were efficient and had Alexa prepared and waiting when Dr Zumdahl arrived. “Good morning, everyone, good to see you again. How are you, Alexa?”

“Bit nervous,” she admitted. “But I'm ready.”

“Good. I need about half an hour to prepare, and then we'll take you in. Mr Holmes, Dr Watson, you can stay here for now, and then you'll have to go to the waiting room. The procedure should be about three hours, and I'll come and get you when it's over. You'll be able to see her when we move her from recovery into her own room.”

“There's no way we can watch?” John asked.

“No, sorry, we're not set up for that.” She patted Alexa's foot. “I'll see you in a bit.”

The half hour passed quickly, and a pair of nurses arrived to point Sherlock and John to the waiting room, then rolled Alexa through the corridors to the operating room. She looked around at the gleaming equipment for a few seconds before a dark-haired male doctor appeared at her side. “Hello, Alexa. I'm your anaesthesiologist, Dr Gluckstein. I'll be taking care of you while Dr Zumdahl does her thing.”

“Hi,” Alexa responded.

“I've started the drug in your IV,” he said. “You should start feeling it pretty soon. We're going to strap you to the table now, since we can't use a muscle relaxant.”

Leather straps were pulled across her hips and legs, and her brain was already starting to get fuzzy, but she smiled at Dr Zumdahl when she came in. “All set?”

“Yeah,” Alexa said. “Let's … do this, or something.”

The doctors chuckled as they pulled their masks on. “Here comes your oxygen,” said Dr Gluckstein, but Alexa was out before it touched her face.

 

It was the longest wait of John's life.

Sherlock was a writhing ball of nervous energy, alternately pacing the room, absently prodding at cold cases on his phone, and annoying the reception staff until they threatened to have security escort him out. John had brought a novel, and he tried to read it, but his eyes trailed over the words without forming meaning. After two hours, he gave up, and dragged Sherlock to the canteen for coffee that neither of them enjoyed.

Finally, nearly four hours after they had been separated from Alexa, Dr Zumdahl came in, still wearing her scrubs. “Mr Holmes, Dr Watson.”

“How was it?” Sherlock demanded.

She smiled kindly. “Textbook. Everything went perfectly, and she's in recovery now. When she wakes up, we'll take her up to her room, and you'll be able to see her then.”

“Thank you,” John said, and turned just as Sherlock's arms enveloped him in a surprising hug. “You okay, Sherlock?”

“Yes.” His voice was a bit rough.

“Sure?”

“Yes.” His arms tightened, and John returned the hug, relaxing into the comforting warmth with the knowledge that their daughter was done with the most risky part of her treatment.

 

Alexa was still fairly heavily drugged on anaesthesia and painkillers when they finally got to see her, but she smiled and said she felt fantastic, despite the drain in her incision and large ice pack on her neck. The nurse explained that the drain would keep the swelling down, and speed her recovery. They were all pleasantly surprised that her voice didn't seem affected at all, and they spent the afternoon talking about nothing and watching daytime television shows. Marie arrived with her mother after school, and they stayed for a bit until Alexa started dozing off. John and Sherlock lingered as long as they could, until their stomachs were growling and the nurses had to insist that visiting hours were over, and they would have to come back in the morning. Alexa woke up long enough to say goodbye, and then they left reluctantly, with promises to return as soon as they were allowed the next morning.

Alexa slept fitfully that night, and was relieved when the morning sun finally hit her window and Dr Zumdahl arrived a bit later for a final check-up and to remove her drain. She was trying to eat breakfast when John and Sherlock arrived again, and she pushed the tray of food at them. “It feels too weird to swallow solid food,” she complained, and John had a nurse bring her an orange ice pop and another cup of tea, which she enjoyed with relish as Sherlock ate the hot breakfast the hospital had provided.

When the results of her morning blood work were deemed acceptable, she was finally released, and fell asleep on Sherlock's shoulder in the cab on the way home.

**Notes for the Chapter:**

> Dr Zumdahl is based pretty much exactly on my surgeon, Dr Deborah Kerlin. If you live in the San Francisco area and need thyroid surgery, go to her. She was absolutely wonderful, and she's associated with a /very/ nice hospital in Walnut Creek, where she does the majority of the thyroid surgeries.
> 
> I know I said that we'd hear details about Alexa's miserable night in hospital, but I decided this chapter was long enough and that bit wasn't terribly important (and Alexa doesn't have the psychological maladies that I do, so it probably wasn't as bad). Thank god for the Golf Channel or I would have gone completely insane.


	4. Iodine

**Summary for the Chapter:**

> Alexa wraps up her cancer treatments.

John still had the nightmares, sometimes. They had become much less frequent when he first moved into 221B Baker Street, and had all but stopped when he had started sharing a bed with Sherlock.

But he still had them. Sometimes.

“John. _John!_ ”

John woke with a gasp, heart pounding, cold sweat dripping down his face, tears threatening. Sherlock was raised on one elbow beside him, the other hand firm on his shoulder, but John couldn't see his face in the dark. “You were having a nightmare.”

He regained enough control over his breathing to speak. “Yes, I know.” He sat up and rubbed his face with both hands.

“Afghanistan?”

“Sort of.” He stood up shakily. “I need to go check on Alexa.”

Sherlock sat up at that. “What for? It's three in the morning. She's asleep, upstairs.”

“Yes, I _know_ , but … I still need to.”

He opened the door, and Sherlock followed him up the stairs, but stopped at the threshold as John pushed the door open and crossed the room to where Alexa was sleeping.

John restrained his impulse to touch her, to wake her. She was lying on her back, breathing slowly and deeply. The bandage low on her neck was just visible above the blanket, and John forced himself to look at it, to see how clean and white it was.

Finally, he turned around and quietly left the room. Sherlock touched his shoulder gently as they descended the stairs, and got back into bed.

“What was different this time?” Sherlock murmured as they pulled the blankets up.

“It started out the same,” John said softly. “The ambush, and a soldier had been hit and I went to him. But then I got there and I turned him over, and it was Alexa, and she was bleeding out from her neck wound, and I panicked and I couldn't move, all I could do was stare at her, at all the blood, and watch as she died in front of me. Her _face_ , Sherlock … she knew what was happening, and she wanted me to do something, but I _couldn't_ , and I felt so helpless.”

Sherlock moved closer and wrapped all of his long limbs around John, surrounding him, pulling him close, as the other man choked back sobs. “It's all right, John. She's fine, thanks to you.” He pressed a kiss to the crown of John's head. “You're an excellent doctor and a superb father.”

John crowded in even closer to Sherlock's chest, rubbing his tears on the soft shirt. “Thank you.”

Another small kiss. “I love you.”

 

The morning came much too quickly for their liking, and all three of them hurried through showers and breakfast to go to Alexa's first post-op appointment with Dr Zumdahl. John and Sherlock were squeezed into the corner again as the doctor carefully pulled the tape off Alexa's neck, revealing a red line about two inches long. “Looks fantastic,” she said, handing Alexa a mirror. “You can start using scar gel on it now, if you want. It's closed up beautifully.”

Alexa poked at it a little. “Where are the stitches?”

“Dissolved,” Dr Zumdahl said. “And the ones that were on the outside were stuck to the tape, so they just came off. How's the swelling been?”

“No problem at all, after the first couple of days,” Alexa said, handing the mirror back. “You have the pathology report?”

“Yes, and I've made copies.” She opened Alexa's file and pulled out three sheets of paper. One went to John and Sherlock, and one to Alexa. “Your tumour was right on the edge of a microtumour classification; its maximum dimension was one centimetre. They confirmed it was a papillary carcinoma. The rest of the thyroid gland was healthy and showed no signs of disease.”

“But the lymph nodes,” John prompted – that was where his eye had immediately gone.

“Yes. Of the twelve lymph nodes we took out, three of them showed metastases – and like I said before, that's common, even in early stage thyroid cancer. That means your endocrinologist will recommend a radioiodine ablation, which should kill any remaining metastases, and the rest of the thyroid bed that the surgery left behind.”

“When can we schedule that?” John asked.

“I think they normally recommend at least four weeks post-op, so two weeks from now at the earliest. And it won't be through me, your endo will know more. But for my part, I can say you're looking great. I'll want to see you again in a few months to check the scar's progress.”

 

“Remind me again why we're _all_ going low-iodine?” Sherlock whined.

“Because,” John snapped, “we are good fathers and we don't want Alexa to feel like she's missing out.”

“But she _is_ ,” Sherlock said. “We all are. You're a terrible baker and I'd do anything for dim sum.”

“Anything?”

“Don't try me, Doctor Watson.”

“Oh, I would never.”

“And for those of us with functioning thyroids, isn't it not so great to go low-iodine anyway?”

“Not terribly, no. And I picked up a handful of iodine supplements from the clinic, which we'll take a few times just to be safe.” He stirred the sauce that was simmering on the stove. “This should be pretty good, anyway. We'll have it with mashed potatoes tonight.”

“I'm going to be sick of potatoes by the end of this.”

“It's not going to be all potatoes,” John promised. “We can have rice and pasta occasionally. And it's almost Passover – though I suppose you wouldn't know – so you can replace my homemade toast with unsalted matzos, if you like. I'd even go out and buy them for you, the shops are full of them.”

“Unsalted matzos? Sounds dreadful.”

“We'll see.”

 

The two weeks of the low-iodine diet could not possibly have gone by any slower, Sherlock and Alexa agreed as they sat together in the back of the cab on the way to the last in her series of appointments at the nuclear medicine clinic. They had passed more than one evening scheming ways to sneak high-iodine foods into the house and trick John into preparing them, but in the end, their own rationality triumphed.

“I'm so tired of going to this place,” Alexa grumbled. “Four times in a week is too many.”

“You get a scan this time, though,” Sherlock said. “Visual proof that this horrid diet was good for something.”

“I can't believe I'm radioactive right now,” she said, softly so as not to alarm the cabbie.

Sherlock smirked. “Can't feel any superpowers developing?”

“No, I think the 131 I get today will do that. They kept saying yesterday that the 123 was harmless.”

“Iodine-123 decays by electron capture; it _is_ harmelss.  Is that really all they did yesterday, give you that pill?”

Alexa nodded. “Well, and the lab order for the TSH and pregnancy test.”

“I still don't see why that one is necessary.”

“Yes you do, you're just my Dad and it makes you uncomfortable.” She leaned on him. “I promise you it'll be negative.”

He raised an eyebrow. “It had better be.”

“If it's positive, we'll start a new religion, how about that?”

“Only if I get to be Pope.”

“Fair enough. But what will that make Papa?”

“The Pope's husband. The new religion doesn't have to make sense in the context of any existing ones.”

Alexa giggled. “I suppose going here every day for a week is better than going off my Synthroid for two weeks. I hear that's absolutely miserable.”

“I can't even imagine,” Sherlock said. “Certainly worse than getting a couple of injections in your bum.”

 

An hour later, Sherlock was pacing the small hallway and building up to a good sulk as Alexa did her best to lie perfectly still in the gamma ray scanner. The technician poked her head out of the control room. “Can I get you anything, Mr Holmes? Coffee, maybe? She's going to be in there for a while.”

“Don't you have to monitor the machine?”

“It's done this a thousand times, and it'll take me thirty seconds to pour coffee. I'm getting some anyway, come on. Just because she's bored doesn't mean we have to be.”

He followed reluctantly, but accepted the cup of coffee and stirred in his usual two sugars before taking a sip. “This is wretched.”

“Yeah,” the tech agreed, walking out of the lounge and back down the hall towards the control room. “But it's hot and caffeinated. After she's done with the scan you can take her to get some good tea; there's a place just a few blocks away. She has to keep fasting until after she gets the pill, but it should only be a couple of hours between when we order it and when it gets here, and then you can go home.”

“What about the low-iodine diet? How long does she have to keep that up?”

“The doctor knows better than I do, sorry. She'll be in soon though.”

After twenty minutes, the first scan was over, and Sherlock followed the technician into the room where Alexa was still lying on the table. “Here's your scan,” the tech said, pulling up a picture on the monitor and turning it to show Alexa. “The only significant uptake is in your neck region, so we're going to do a couple more scans just of your head and neck.”

“Just the neck is good, right?” Alexa asked.

The tech smiled. “Yes, very. And the doctor will be here soon. She'll go over these all with you, and then order your I-131. For now, I'll need you to lie back down and hold still again.”

By the time the detail scans were finished, the doctor had arrived along with Alexa's lab work, which showed the predicted elevated TSH and negative pregnancy. The doctor explained the detail pictures to them – the bright spot in the centre of the neck was the thyroid bed, where some tissue still remained following surgery. This was fully expected. However, there were also two bright spots, still in the neck, but farther away. The doctor explained that these were almost definitely lymph node metastases, but the fact that they showed up so well on the scan meant that the ablation would likely be successful in eradicating them.

Afterwards, Sherlock took Alexa to the cafe that the tech had recommended, where the waitress scowled behind their backs as they drank tea but didn't order any food, and they watched people go by outside and deduced their deepest secrets.

Finally, the call came from the clinic that Alexa's radioactive pill was ready. The doctor gave Alexa a packet of information, including a long list of things that she was forbidden from doing during her five-day radiation quarantine. “So if you want to hug your dad, this is your chance,” the doctor said.

Alexa leaned into Sherlock, and he squeezed her tightly. “John will be disappointed he missed this.”

“He gave me one before we left this morning,” she said. “He knew.”

They released, and Alexa signed the paperwork that she agreed to obey the quarantine. “Radiation time?” she said eagerly.

The doctor chuckled. “Yes, radiation time. Jean will take care of you. Any questions, please do call me.”

“Of course.”

The pill-taking process was much the same as the previous day, though this time the technician was wearing a lead apron and unpacked the pill behind a shield before handing Alexa a little cup of water. “So this is the same as before. I'll hand you the tube, you tip the pill into your mouth without touching it with your hands, and then swallow it with all the water there. Ready?”

“Ready.”

The pill was very small, Sherlock noticed, just before Alexa put it into her mouth. Hard to believe such a tiny thing could cure her cancer.

“Open your mouth,” the tech said. “I just have to check you actually swallowed it.”

Alexa obeyed, and the tech nodded, satisfied. “You're all set, then. Wait an hour before you eat anything, and call us immediately if you vomit in the next six hours.”

“You think I might?”

“Don't worry,” the tech smiled. “It's very rare, but if it does happen, it's a serious radiation hazard. I'm sure you'll be fine. Just take it easy, and remember all the quarantine procedures.”

 

Five days later, Alexa's quarantine was officially over. They celebrated by going out for sushi, and then all piling on the couch together to watch a movie. Alexa sprawled shamelessly across both of them, and her fathers found they didn't mind.

“So this is it,” John said as the opening credits started. “No more cancer.”

“Well, almost,” Alexa said. “I've got to go back for the follow-up scan tomorrow, and then again next year.”

“Scans don't count,” John said, rubbing her feet. “As far as I'm concerned, you are officially cured.”

She flexed her toes with a happy sigh. “Nothing feels quite as good as hearing that from you, Papa.”

John smiled, and Sherlock pressed a warm kiss to his temple. The ordeal that had occupied their lives for the past five months, that had made them feel more afraid and helpless than they had ever been – which was saying a lot, given their profession – was over. The only remaining relics were the annual check-ups, Alexa's scar – even now, faded so much that it was barely visible to those who didn't know where to look – and the little pills that she would take every day for the rest of her life.

All in all, not such a terrible thing to live with.

 

THE END

**Notes for the Chapter:**

> There are two ways of preparing for a radioiodine ablation, and Alexa got to do the new-fangled one like I did – you get two injections of a drug called Thyrogen, which raises your TSH (thyroid stimulating hormone), making your thyroid cells take up iodine even more than usual. The old-fashioned way to raise TSH is to go off the thyroid replacement for a while, which is miserable because you spend the whole time hypothyroid (exhausted, moody, etc) and you still have to be eating low-iodine, which is the hugest pain in the ass in the entire world (I never want to see another unsalted matzo). See the ThyCa website for information on the low-iodine diet. (And don't be fooled – there's no reason for anyone to go on this diet unless they are a thyroid patient. It is not beneficial in any way, and healthy people need iodine.) (As of this past spring, Thyrogen was in a worldwide shortage because of manufacturing shenanigans. Luckily for me, there was a clinic in the area that had it. Even more luckily, my health insurance covered it fully – regular price it would have been over $2000 just for the injections. My insurance also covered the I-131 pill, which cost over $40,000. Yes, $40,000 for a pill smaller than a Benadryl. Cancer is EXPENSIVE.)
> 
> Once your TSH is up, they give you a pill of radioactive I-123, which emits high-energy gamma rays that are great for imaging, but doesn't damage your body tissues. My nuclear doc likes to say this is the kind they give to babies to be sure they have thyroids. Then, you get your pill of I-131, which decays by a different mechanism that literally nukes the cells it gets into, which are, ideally, thyroid cells and only thyroid cells. If everything went perfectly, when you go back for another I-123 scan, nothing shows up at all because there are no thyroid cells left to take up the iodine. I'm not to this point yet, but I'm sort of looking forward to it (even though it means I'll have to do the low-I diet again). A clear scan means that I've really and truly beaten thyroid cancer!


	5. Epilogue: Ultrasound

**Summary for the Chapter:**

> One year later ...

Once again, Sherlock was the first under Dr Giancoli's ultrasound wand, and he grumbled when the doctor drizzled the cold, sticky gel on his neck.

"Man up," Alexa chided.  "At least there's no needle this time."

"Hopefully," Dr Giancoli said.  "Assuming your nodules are the same as they were last year."

"You've carefully studied my old pictures, of course?"

"Of course.  I'll need to look at them side by side, but I should be able to tell pretty well whether anything big has changed."

"You palpitated my neck just now, couldn't you tell from that, at least a little?"

The doctor sighed.  "Mr Holmes, I've felt hundreds of thyroids since the last time I saw you.  I can't possibly remember how your particular neck felt a year ago."

"Shut up and let him do the thing, Dad."

Sherlock huffed in frustration, but kept quiet and still while Dr Giancoli moved the wand around on his neck, sweeping slowly from clavicle to jaw three times on each side and providing a murmured narration of the structures that were revealed.  "All your non-thyroid things look normal.  The nodule on this side is still small, hard to gauge the exact size right now ..."

After ten long minutes he finished, and Sherlock squirmed away as quickly as he could, hastily grabbing a handful of tissues to wipe up the gel that was already dripping down his bare chest.  The doctor bit back a sigh as he turned to Alexa.  "Isn't your other dad a doctor?"

"Yeah, sorry he couldn't come, he's actually working today.  Missed a spot," she said to Sherlock, who scrutinised his body.  "Normally Papa can ..."

"Alexa," Sherlock warned, "think very hard about how you're going to finish that sentence."

"You don't scare me.  What're you gonna do, make me walk home?"

He scowled as he shrugged back into his shirt.  "I might."

"Whatever you say."  She pulled the paper gown over her camisole and sat on the edge of the table.  "Ready?"

"Go ahead and lie down, I'm almost ready here."

She leaned back and Sherlock adjusted the bolster under her shoulders.  "You don't have to be afraid."

"I'm not.  No needles this time, remember?"

"Still not exactly fun."

"I'm fine, Dad.  Relax."

Sherlock sat down when Dr Giancoli picked up the ultrasound gel and applied it to Alexa's neck.  He fidgeted while he stared at the changing images on the machine's screen, occasionally interrupting the doctor's narration with pointed questions.  Alexa let the sounds wash over her and focussed on breathing steadily, on relaxing despite the unnerving pressure and sticky chill.

It took a bit longer than Sherlock's scan, partly due to the detective's interruptions and partly because the doctor spent a few minutes carefully analysing Alexa's lymph nodes.  Finally he pronounced her neck clear, and started wiping up the gel.  "Congratulations, Alexa, there's no regrowth of your thyroid tissue."

She breathed a sigh of relief, then grinned when her father spoke up again.  "I should hope not.  She did the radioactive ablation, wasn't that the point?"

"Yes," said Dr Giancoli patiently, "but I'm sure you know, Mr Holmes, bodies don't always work the way we hope.  Sometimes a few cells escape the surgery and the radiation, and you can't be too careful.  That's why we do these checks."

"It's illogical.  The point was to kill everything the first time so there was no chance of recurrence."

Alexa tilted her head back farther and looked at him.  He caught her eye and looked away awkwardly.  "Don't mind him."  She took a handful of tissues from the doctor and sat up, dabbing at the bits of gel that were still under her ears.  "He worries and he doesn't know how to express it."

He stood up and handed her her cardigan in exchange for the paper gown.  "You were supposed to be cured after all that."

"I was.  We nuked it from orbit, remember?"

He snorted a laugh.  "I guess a few cockroaches could have survived."

"Great," Dr Giancoli interrupted.  "Cancer as cockroaches.  Before I let you two go, anything else going on?  Alexa, I see you're still on the 175, and your labs look good.  T3 and T4 are in the normal range, and TSH is very low.  Feeling all right?"

"Yeah.  Much better than when I was on the 150.  I feel normal again."

"Good, normal's what we want.  And Mr Holmes ..." He flipped to the other chart.  "Your blood work is normal too, and from what I saw today I think your nodules are still not a problem.  Any complaints?"

"No."

"Good.  I'll have a look at the pictures a little later and give you a call if there's anything remarkable, all right?"

"All right."  He picked up his jacket.  "Anything else?"

"I'll mail you a lab order, I'd like you to do some blood work again in six months.  Alexa will need to do it again in a year, and come back for another ultrasound."

"Tedious."

"Dad!"

Dr Giancoli winked at her.  "You can take him home now."

Sherlock was on his phone by the time they got outside, and Alexa looped her arm through his as they walked down the street.  "Hello, John.  ... Yes, everything went fine, we're just leaving now.  When will you be done?  ... Can't you go early?  ... Because our daughter has just received confirmation that she's cancer-free, I think that deserves an afternoon off."  He sighed peevishly and held the phone out to her.  "He wants to talk to you."

She took it with a smirk.  "Hi, Papa."

"Hello, love.  I hear congratulations are in order."

"I haven't done anything."

"Of course you have!  You went through all that stuff a year ago, and you've been great about taking your pill every day.  I know it doesn't feel like much, but it all adds up to you being cured."

She grinned.  "I suppose you're right."

"Oh, it's good to hear that sometimes.  And speaking of your know-it-all dad, why did he call?  Usually he prefers to text."

"Couldn't say.  Maybe he just couldn't wait to tell you the good news in person."

"Well, that's probably true.  Now I'm supposed to be here until five, but I may be able to get away just a bit early.  Not early enough to have lunch with you two, I'm afraid.  But earlier than I was scheduled."

"How soon?"

"I don't know, I have to talk to Dr Sawyer.  But it's been quiet today, and I'll let you know."

"Okay.  See you later then."

"Bye, sweetheart.  And give your dad a hug, yeah?  He wants one but he won't say it."

She glanced up at Sherlock, who was pretending not to listen.  "Yeah, all right.  Bye!"

She rung off, then stopped Sherlock with gentle pressure on his arm and slipped the phone into his pocket before pulling him into a tight hug.  He melted into it instantly, nearly scooping her off her feet.  She clung to his shoulders.  "I'm really cured."

"I'm so proud of you."  His voice was barely a whisper beside her ear.

"Thanks, Dad."

They held on for a long minute before they reluctantly parted, and Sherlock tried to surreptitiously wipe some moisture from his eyes.  "What did John have to say?"

"He's going to try to come home a bit early."

"But not early enough for lunch."  He scanned the street as they walked.  "Want to get something while we're out?"

"Sure.  Sushi?"

His eyes sparkled as he looked at her.  "There's an excellent place two blocks over."

**Notes for the Chapter:**

> I got inspired to write this earlier this week while I was lying on my endocrinologist's exam table while he took pictures of my neck, and I figured Sherlock and Alexa should have a wrap-up as well. I don't know if benign nodules need annual ultrasound exams, but I figured Sherlock should get one again.
> 
> Alexa takes levothyroxine to replace her thyroid function. Typical doses following a total thyroidectomy are anywhere from 100 micrograms/day all the way up to 300, and it depends on an enormous range of factors that can't be predicted well. I take 150, and I have a friend who takes 200. I split the difference for Alexa. And sometimes a small change in dosage (I recently went up from 137 to 150) can make only a small difference in your serum T4 and TSH, but have a big effect on how you feel. When my dose was too low, I was easily overwhelmed (and had more panic issues) and didn't have the energy to do much beyond what I needed to do every day. With only a slight increase in dose, I have enough to do things like go to the grocery store and fold the laundry.
> 
> The pictures of my neck were unbelievably boring, guys. Vein, artery, larynx, nodes. But boring is good when you're a ThyCa survivor! You can see the picture [here](http://ladymac111.tumblr.com/post/55043350790/aww-yeah-check-out-the-inside-of-my-neck-no).

**Author's Note:**

> Thyroid Cancer Survivors Association: thyca.org


End file.
